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Dexamethasone Reduces Postoperative Nausea in Pediatric Upper Endoscopy With Deep Sedation

A Randomized Controlled Trial

Moheimani, Hamed*; Yaseri, Mehdi

Journal of Pediatric Gastroenterology and Nutrition: September 2019 - Volume 69 - Issue 3 - p 281–286
doi: 10.1097/MPG.0000000000002398
Clinical Trials: Gastroenterology
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Objectives: We aimed to evaluate the effect of a single dose of preoperative dexamethasone on postoperative nausea and vomiting (PONV), a frequent complication and a major cause of delayed recovery in pediatric upper gastrointestinal endoscopy (UGIE) under sedation.

Methods: In this double-blind randomized controlled study, 98 children aged 2 to 14, with American Society of Anesthesiologists status I to II, and undergoing elective UGIE with deep sedation were included and randomly assigned to 2 groups. Preoperatively, after anesthesia induction with sodium thiopental and maintenance with sevoflurane, patients in the intervention (n = 49) and control (n = 49) groups, respectively received 0.1 mg/kg i.v. dexamethasone and 2 cm3 i.v. 0.9% saline. Postoperatively, PONV incidence was measured as the primary outcome.

Results: PONV incidence was significantly less in dexamethasone group (8.2%) compared to the control group (26.5%) (difference = 18.3%, 95% confidence interval: 3.4%−33%, P = 0.016). For secondary outcomes, between-group differences were not statistically significant: incidence of bronchospasm or laryngospasm (both 4.1%, P = 1); emergence delirium assessed with Pediatric Anesthesia Emergence Delirium scale (5.9 ± 3.4 vs 5.7 ± 3.2, P = 0.751); Modified Aldrete score at 0 minutes (9.4 ± 0.8 vs 9.3 ± 0.9, P = 0.909) and at 5 minutes (9.5 ± 0.7 vs 9.4 ± 0.9, P = 0.527); and recovery time (21.1 ± 6.6 vs 23.4 ± 8.6 minutes, P = 0.130).

Conclusions: A single preoperative dose of i.v. dexamethasone reduces PONV in children undergoing elective UGIE with deep sedation, but has no significant effect on the patient recovery time or the incidence of postoperative bronchospasm or laryngospasm and emergence delirium.

*Students’ Scientific Research Center, School of Medicine

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Address correspondence and reprint requests to Dr Hamed Moheimani, Students’ Scientific Research Center, Tehran University of Medical Sciences, Number 11, Valadi st., Hafez st., Karimkhan st., 1593919654, Tehran, Iran (e-mail: h-moheimani@alumnus.tums.ac.ir).

Received 12 February, 2019

Accepted 24 April, 2019

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org).

This work was conducted as a student research project supported by the office of Vice-chancellor for Research, Tehran University of Medical Sciences, Tehran, Iran.

The authors report no conflicts of interest.

Clinical Trial Registration Number IRCT20180929041173N1 at irct.ir

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,